Immunization Practices Improvement Initiative (IPII)

1. Immunization Practices Improvement Initiative (IPII) A Process Evaluation of a Level 1 AFIX Program Susan Ashkar, MA Melissa Ely Moore, MPH Immunization Program Los Angeles County Department of Health Services

2. AFIX Program • Program Operations • Assessment • Feedback • Incentives • eXchange of Information • Program Evaluation

3. Assessment and Feedback ActivitiesLos Angeles County Immunization Program (LACIP) • Community Workers • CASA • Nurse consultant • Quality Assurance Review (QAR) • Feedback • Action Plan • Disjointed efforts

4. Immunization Practices Improvement Initiative (IPII) The goal of the IPII is to raise immunization rates and improve provider practices by: • implementing evidence-based interventions to improve provider immunization practices • instituting routine and proactive follow-up • increasing efficiencies by assessing office systems • increasing coordination and collaboration among LACIP staff

5. Program OperationsLevel 1 Standards Partially Met • Written strategic plan for AFIX activities • Clearly defined methods for evaluating progress • QAR and CASA results • Method for evaluating the progress at achieving goals • Monthly Case Management Team meeting where goals & timeline for improvement are set

6. Assessment Levels 1-2 Standards Met • Written CASA and QAR protocols • CASA protocol: • Age range to be assessed 24-35 months • Inclusion Criteria • Series to be assessed 4:3:1:3:3 • Demographics to be collected • MOGE is defined • QAR observation and chart review

7. Case Management Team • Composed of nurses, community workers, research analysts & program managers • Discuss assessments, office practices • Develop improvement plan • What interventions are needed • Who will make the follow-up visits • Frequency of follow-ups • Incentives to offer

8. Case Managers

9. East Area Field Unit • Karen Roby • Judy Graham • Lisa Velasco • Vickie Washington • Mary Porras • Anthony Williams (not pictured) • Kay Park (not pictured) • Sonia Martinez (not pictured) • Sherry Russell (not pictured) • Susana Sevilla, Case Manager

10. East Area Field Unit

11. Southwest Area Field Unit • Claudia Davila • Cruz Porras • Arnold Hartoonian • Na’ama Hadar • Paul Miller • Ricardo Ibarra • Jose Salazar • Anna Salinas (not pictured) • Shawntay Davis (not pictured) • Andrew Pourmohsen • (not pictured) • Lucinda Clare (not pictured) • Pierre Nsilu, Case Manager

12. Southwest Area Field Unit

13. North Area Field Unit • Lidoosh Hartoonian • Becky Bravo • Patricia Klee • Eva Rodriguez • Sevak Karapetyan • Bethany Lorca (not pictured) • Susana Sevilla, Case Manager

14. North Area Field Unit

15. FeedbackLevels 1 –2 Standards Met • Plan is presented to provider • Assessment results reviewed • Goals set, Healthy People 2010 discussed • LACIP interventions • In-services, training offered • Reminder/Recall, documentation, immunization update, simultaneous administration, missed opportunities • Follow-up visits/phone calls to ensure change implemented

16. IncentivesLevel 1 –2 Standards Met • Written Incentive Distribution Policy • Clearly defined list of formal and informal incentives • certificate of appreciation signed by LACIP Director and Medical Director • gift cards, stethoscopes • promotional items: • stress balls, pens, pocket planners

17. eXchange of InformationLevel 1 Standards Met • Print resources available • Vaccine Information Statements (VIS) • current immunization schedule • Inservices offered monthly and as needed • Info on satellite conferences • Access to LACIP website and others • At feedback

18. Program EvaluationLevel 1 –2 Standards Met • Utilize Access database to document: • assessment results • site visits • clinic interventions by LACIP staff • staff responsible • date to complete intervention • incentives given • Information is gathered at CM meetings, via telephone and email

19. Program OperationsToward Levels 2-3 • Clearly defined method for identifying and recruiting providers for future IPII • Established relationships with Department of Health, Community Clinics (contract & non-contract), VFC • Work with health plans and IPAs

20. AssessmentToward Levels 2-3 • Monitoring AFIX staff members implementation of the assessment protocol • Updating QAR protocol • Documentation of interaction with providers by staff • Maintenance for clinics doing well

21. FeedbackToward Levels 2-3 • Standardized interventions • Resource materials for provider • binder • Services summary • vaccine usage • assessment history • recommendations

23. eXchange of InformationToward Levels 2 - 3 • Sponsor provider exchange & recognition event Summer 2005 • Develop a newsletter highlighting best practices to IPII providers • Grand Rounds

24. IPII First Year • 36 Community Clinics (Contract) • 2001-2003 3 year CASA average 76% UTD* • 2004 CASA average 88% UTD* *4:3:1:3:3 series at 24-35 months of age

25. First Year Project Report Community Clinics (Contract) 2003 and 2004 CASA Results 4:3:1:3:3 Series 24-35 months

26. Challenges • Providers • Limit visits • Provide solutions, attainable goals • LACIP staff • Change • Workload • Consistent follow-up • Frequent Case Management meetings

27. Next Steps • Identify medium sized IPA to work with • Fully meet Standards for Levels 2 and 3 • Continue to evaluate and improve IPII

28. Susan Ashkar sashkar@ladhs.org Immunization Program 3530 Wilshire Blvd Suite 700 Los Angeles, CA 90010 Phone # 213-351-7800 Fax # 213-351-2780 www.lapublichealth.org/ip/